TY - JOUR
T1 - Occurrence and significance of fluoroquinolone-resistant and ESBL-producing Escherichia coli and Klebsiella pneumoniae complex of the rectal flora in Ghanaian patients undergoing prostate biopsy
AU - Labi, Appiah Korang
AU - Obeng-Nkrumah, Noah
AU - Dayie, Nicholas T.K.D.
AU - Addo, Ben Molai
AU - Osei, Mary Magdalene
AU - Fenny, Ama
AU - Egyir, Beverly
AU - Mensah, James Edward
N1 - Publisher Copyright:
© 2022 The Author(s). Published by Oxford University Press on behalf of British Society for Antimicrobial Chemotherapy.
PY - 2022/12/1
Y1 - 2022/12/1
N2 - Background: Reports suggest that fluoroquinolone (FQ)-resistant and ESBL-producing rectal flora are associated with infectious complications in men undergoing transrectal ultrasound-guided prostate needle biopsy (TRUS-B) Objectives: We investigated the relationship between carriage of FQ-resistant and ESBL-producing Escherichia coli and Klebsiella pneumoniae complex of the rectal flora, and the 30 day incidence rate of post-TRUS-B infectious complications. Methods: From 1 January 2018 to 30 April 2019, rectal swabs of 361 patients were cultured pre-TRUS-B for FQ-resistant and ESBL-producing flora. Patients were followed up for 30 days for infectious complications post-biopsy. Multivariable logistic regression analyses were used to identify risk factors. Results: Overall, 86.4% (n=312/361) and 62.6% (n=226/361) of patients carried FQ-resistant and ESBL-producing E. coli and K. pneumoniae complex, respectively. Approximately 60% (n=289/483) of the FQ-resistant and 66.0% (n=202/306) of the ESBL-positive isolates exhibited in vitro resistance to the pre-biopsy prophylactic antibiotic regimen of levofloxacin and gentamicin. Amikacin and meropenem were the most effective antibiotics against the MDR rectal E. coli and K. pneumoniae complex (78.7% and 84.3%, respectively). The 30 day incidence rate for post-biopsy infections was 3.1% (n=11/361), with an overall high probability (96.9%) of staying free of infections within the 30day period post-TRUS-B. Antibiotic use in the previous 3months was a risk factor for rectal carriage of FQ-resistant and ESBL-positive isolates. Rectal colonization by ESBL-positive E. coli and K. pneumoniae complex comprised an independent risk factor for post-biopsy infectious complications. Conclusions: The findings suggest that a change in prophylactic antibiotics to a more targeted regimen may be warranted in our institution.
AB - Background: Reports suggest that fluoroquinolone (FQ)-resistant and ESBL-producing rectal flora are associated with infectious complications in men undergoing transrectal ultrasound-guided prostate needle biopsy (TRUS-B) Objectives: We investigated the relationship between carriage of FQ-resistant and ESBL-producing Escherichia coli and Klebsiella pneumoniae complex of the rectal flora, and the 30 day incidence rate of post-TRUS-B infectious complications. Methods: From 1 January 2018 to 30 April 2019, rectal swabs of 361 patients were cultured pre-TRUS-B for FQ-resistant and ESBL-producing flora. Patients were followed up for 30 days for infectious complications post-biopsy. Multivariable logistic regression analyses were used to identify risk factors. Results: Overall, 86.4% (n=312/361) and 62.6% (n=226/361) of patients carried FQ-resistant and ESBL-producing E. coli and K. pneumoniae complex, respectively. Approximately 60% (n=289/483) of the FQ-resistant and 66.0% (n=202/306) of the ESBL-positive isolates exhibited in vitro resistance to the pre-biopsy prophylactic antibiotic regimen of levofloxacin and gentamicin. Amikacin and meropenem were the most effective antibiotics against the MDR rectal E. coli and K. pneumoniae complex (78.7% and 84.3%, respectively). The 30 day incidence rate for post-biopsy infections was 3.1% (n=11/361), with an overall high probability (96.9%) of staying free of infections within the 30day period post-TRUS-B. Antibiotic use in the previous 3months was a risk factor for rectal carriage of FQ-resistant and ESBL-positive isolates. Rectal colonization by ESBL-positive E. coli and K. pneumoniae complex comprised an independent risk factor for post-biopsy infectious complications. Conclusions: The findings suggest that a change in prophylactic antibiotics to a more targeted regimen may be warranted in our institution.
UR - http://www.scopus.com/inward/record.url?scp=85144558332&partnerID=8YFLogxK
U2 - 10.1093/jacamr/dlac113
DO - 10.1093/jacamr/dlac113
M3 - Article
AN - SCOPUS:85144558332
SN - 2632-1823
VL - 4
JO - JAC-Antimicrobial Resistance
JF - JAC-Antimicrobial Resistance
IS - 6
M1 - dlac113
ER -
